Based on recommendations from the Renal and Cardiovascular Advisory Committee, the Food and Drug Administration approved prasugrel (Effient) for the treatment of patients with acute coronary syndrome undergoing percutaneous transluminal angioplasty in July of this year.1 Dual antiplatelet therapy with clopidogrel and aspirin is currently the standard of care for these patients. Similar to clopidogrel, prasugrel is a thienopyridine that inhibits the adenosine diphosphate P2Y12 receptor in platelets, preventing aggregation, which may trigger subsequent thrombus formation.2 The FDA approval of prasugrel followed an extensive 18-month review. Numerous issues have been raised concerning the comparative efficacy and safety of this agent and whether it offers any significant clinical advantage over clopidogrel. This article will discuss these issues and the likely role of prasugrel in clinical practice.
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